1. “Complex needs patient" means an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation.
2. “Complex rehabilitation technology" means items classified within Medicare as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary. “Complex rehabilitation technology” includes complex rehabilitation manual and power wheelchairs, adaptive seating and positioning items, and other specialized equipment such as standing frames and gait trainers, as well as options and accessories related to any of these items.
3. “Individually configured" means having a combination of sizes, features, adjustments, or modifications that a qualified complex rehabilitation technology supplier can customize to the specific individual by measuring, fitting, programming, adjusting, or adapting as appropriate so that the device operates in accordance with an assessment or evaluation of the individual by a qualified health care professional and is consistent with the individual's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.
4. “Medicare" means coverage under Part A or Part B of Title XVIII of the federal Social Security Act,
42 USC 1395 et seq.
5. “Qualified complex rehabilitation technology professional" means an individual who is certified as an assistive technology professional by the Rehabilitation Engineering and Assistive Technology Society of North America.
6. “Qualified complex rehabilitation technology supplier" means a company or entity that meets all of the following criteria:
a. Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology.
b. Is an enrolled supplier for purposes of Medicare reimbursement that meets the supplier and quality standards established for durable medical equipment suppliers, including those for complex rehabilitation technology under Medicare.
c. Is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology.
d. Requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient.
e. Has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells.
f. Provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology.
7. “Qualified health care professional" means any of the following:
a. A physician or physician assistant licensed under subch. II of ch. 448.
b. A physical therapist licensed under subch. III of ch. 448.
c. An occupational therapist licensed under subch VII of ch. 448.
d. A chiropractor licensed under ch. 446.
(b) The department shall promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. The department shall include in the rules all of the following:
1. Designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes. The department shall include provisions allowing quarterly updates to the designations under this subdivision.
2. Establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers.
3. A requirement that Medical Assistance recipients who need a manual wheelchair, power wheelchair, or other seating component to be evaluated by all of the following:
a. A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier.
b. A qualified complex rehabilitation technology professional.
4. Establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure, and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients.
5. A requirement for contracts with the department that managed care plans providing services to Medical Assistance recipients comply with this subsection and the rules promulgated under this subsection.
6. Protection of access to complex rehabilitation technology for complex needs patients.
(c) This subsection is not intended to affect coverage of speech generating devices, including healthcare common procedure coding system codes E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, and E2599, under the Medical Assistance program.
59,927
Section 927
. 49.45 (23) (g) 1. f. of the statutes is created to read:
49.45 (23) (g) 1. f. Provide employment and training services to childless adults receiving Medical Assistance under this subsection.
59,928b
Section 928b. 49.45 (23) (g) 2. of the statutes is repealed.
59,928d
Section 928d. 49.45 (23) (g) 3. and 4. of the statutes are created to read:
49.45 (23) (g) 3. If the secretary of the federal department of health and human services approves any portion of the waiver amendment requested under subd. 1., the department shall, no later than the first day of the 4th month beginning after that approval, submit to the joint committee on finance a report that includes all of the following:
a. A description of each component of the waiver amendment that is approved and any pertinent information on the department's plan for implementation.
b. An estimate of the effect of implementation of the approved portions of the waiver amendment on enrollment in and the budget of the Medical Assistance program in the fiscal biennium in which approval occurs and in future fiscal bienniums.
4. The department may not implement any approved portion of the waiver amendment requested under subd. 1. unless the joint committee on finance meets under s. 13.10 and approves the implementation of that portion of the waiver amendment. In a meeting under s. 13.10 to review the report submitted under subd. 3., the joint committee on finance may approve or disapprove of the waiver amendment portions that are approved by the federal department of health and human services or may modify the waiver amendment only by removing one or more components of the waiver amendment. The department may implement the waiver amendment only as approved by the joint committee on finance, including any modifications. The department shall, if necessary to implement the waiver amendment as modified by the joint committee on finance, submit a subsequent waiver amendment request to the federal department of health and human services that is consistent with the committee's actions.
59,928f
Section 928f. 49.45 (24n) of the statutes is created to read:
49.45 (24n) Reimbursement for dental services by facilities serving individuals with disabilities. (a) Subject to approval of the federal department of health and human services under par. (b), the department shall distribute moneys in each fiscal year to increase the Medical Assistance reimbursement rates for all eligible dental services rendered by facilities that provide at least 90 percent of their dental services to individuals with cognitive and physical disabilities, as determined by the department. Under this subsection, the enhanced reimbursement rates for dental services would equal 200 percent of the Medical Assistance reimbursement rates that would otherwise be paid for these dental services.
(b) The department shall request any waiver from and submit any amendments to the state Medical Assistance plan to the federal department of health and human services necessary for the Medical Assistance reimbursement rate increase under par. (a). If any necessary waiver request or state plan amendment request is approved, the department shall implement par. (a) beginning on the effective date of the waiver or plan amendment.
59,928g
Section 928g. 49.45 (26g) of the statutes is created to read:
49.45
(26g) Intensive care coordination program. (a) Subject to par. (h), the department shall create and implement a program to reimburse hospitals and health care systems for intensive care coordination services provided to recipients of Medical Assistance under this subchapter who are not enrolled in coverage under Medicare,
42 USC 1395 et seq.
(b) The department shall select hospitals and health care systems to receive reimbursement under this subsection that submit to the department a description of their
intensive care coordination program that includes all of the following:
1. A statement that the hospital or health care system will use emergency department utilization data to identify recipients of Medical Assistance to receive intensive care coordination to reduce use of the emergency department by those Medical Assistance recipients.
2. The method the hospital or health care system uses to identify for intensive care coordination a Medical Assistance recipient who uses the emergency department frequently. The hospital or health care system shall specify how it defines frequent emergency department use and may use criteria such as whether a recipient of Medical Assistance visits the emergency room 3 or more times within 30 days, 6 or more times within 90 days, or 7 or more times within 12 months.
3. A description of the hospital's or health care system's intensive care coordination team consisting of health care providers other than solely physicians, such as nurses; social workers, case managers, or care coordinators; behavioral health specialists; and schedulers.
4. That the hospital or health care system provides to a Medical Assistance recipient enrolled in intensive care coordination through the hospital or health care system all of the following, as appropriate to his or her care:
a. Discharge instructions and contacts for following up on care and treatment.
b. Referral information.
c. Appointment scheduling.
d. Medication instructions.
e. Intensive care coordination by a social worker, case manager, or care coordinator to connect the Medical Assistance recipient to a primary care provider or to a managed care organization.
f. Information about other health and social resources, such as transportation and housing.
5. The outcomes intended to result from intensive care coordination by the hospital or health care system. Outcomes for a Medical Assistance recipient during a 6-month or 12-month period may include successful connection to primary care or the managed care organization as evidenced by 2 or 3 primary care appointments, successful connection to behavioral health resources and alcohol and other drug abuse resources, as needed, or a decrease in use of the emergency room.
(c) The department shall do all of the following:
1. Respond to the hospital or health care system indicating if additional information is required to determine eligibility for the reimbursement program under this subsection.
2. If the hospital or health care system is eligible for the reimbursement program under this subsection, provide a description of the process for enrolling Medical Assistance recipients in intensive care coordination for reimbursement.
(d) The department shall provide as reimbursement for intensive care coordination to eligible hospitals and health care systems participating in the program under this subsection $500 for each Medical Assistance recipient who is not enrolled in coverage under Medicare,
42 USC 1395 et seq., the hospital or health care system enrolls in intensive care coordination. The initial enrollment for each recipient lasts for 6 months, and the health care provider may enroll the Medical Assistance recipient in one additional 6-month period for an additional $500 reimbursement payment. The department shall pay no more than $1,500,000 cumulatively in each fiscal year from all funding sources for reimbursements under this paragraph.
(e) Annually, each hospital and health care system that is eligible for the reimbursement program under this subsection shall submit a report to the department containing all of the following:
1. The number of Medical Assistance recipients served by intensive care coordination.
2. For each Medical Assistance recipient who is not enrolled in coverage under Medicare,
42 USC 1395 et seq., the number of emergency department visits for a period before enrollment of that recipient in intensive care coordination and the number of emergency department visits for the same recipient during the same period after enrollment in intensive care coordination.
3. Any demonstrated outcomes, such as those described in par. (b) 5., for Medical Assistance recipients.
(f) For each hospital or health care system eligible for the reimbursement program under this subsection, the department shall calculate the costs saved to the Medical Assistance program by avoiding emergency department visits by subtracting the sum of reimbursements made under par. (d) to the hospital or health care system from the sum of costs of visits to the emergency department as reported under par. (e) 2. that were expected to occur without intensive care coordination. If the result of the calculation is positive, the department shall distribute half of the amount saved to the hospital or health care system subject to par. (h).
(g) No later than 24 months after the date on which the first hospital or health care system is able to enroll individuals in the intensive care coordination program under this subsection, the department shall submit a report to the joint committee on finance summarizing the information reported under par. (e) including the costs saved by avoiding emergency department visits as calculated under par. (f).
(h) The department shall seek any necessary approval from the federal department of health and human services to implement the program under this subsection. If the federal department of health and human services disapproves the request for approval, the department may implement the reimbursement under par. (d),
the savings distribution under par. (f), or both or any part of the program under this subsection.
59,928h
Section 928h. 49.45 (29y) of the statutes is created to read:
49.45 (29y) Mental health consultation reimbursement. (a) In this subsection, “clinical consultation" means, for a student up to age 21, communication from a mental health professional or a qualified treatment trainee working under the supervision of a mental health professional to another individual who is working with the client to inform, inquire, and instruct regarding all of the following and to direct and coordinate clinical service components:
1. The client's symptoms.
2. Strategies for effective engagement, care, and intervention for the client.
3. Treatment expectations for the client across service settings.
(b) The department shall, subject to any approval necessary from the federal department of health and human services, reimburse clinical consultation from the Medical Assistance program under this subchapter.
(c) By March 31, 2019, the department shall submit a report to the joint committee on finance on the utilization of the clinical consultation services under this subsection.
(d) The department may not provide the reimbursement for clinical consultation that occurs after June 30, 2019.
59,928n
Section 928n. 49.45 (39) (bm) of the statutes is repealed.
59,928r
Section 928r. 49.45 (47m) of the statutes is created to read:
49.45 (47m) Family Care funding. (a) In this subsection, “care management organization” means a care management organization under contract with the department of health services as described under s. 46.284.
(b) The department shall collaborate with care management organizations and the federal centers for Medicare and Medicaid services to develop an allowable payment mechanism to increase the direct care and services portion of the capitation rates to address the direct caregiver workforce challenges in the state.
(c) By December 31, 2017, the department shall seek any federal approval necessary from the federal centers for Medicare and Medicaid services to implement the payment mechanism developed under par. (b).
(d) The department may not implement the plan developed under this subsection unless the department receives federal approval
under par. (c) . The department may submit one or more requests to the joint committee on finance under s. 13.10 to supplement the appropriation under s. 20.435 (4) (b) from the appropriation under s. 20.865 (4) (a) for implementation of the payment mechanism under par. (b). The department may only use moneys for the payment mechanism under par. (b)
if the joint committee on finance approves the request under this paragraph . Notwithstanding s. 13.101, the joint committee on finance is not required
to find that an emergency exists before making a supplementation under this paragraph.
59,928t
Section 928t. 49.45 (53m) of the statutes is created to read:
49.45 (53m) Coverage program for institutions for mental disease. Subject to any necessary waiver approval of the federal department of health and human services, or as otherwise permitted under federal law, the department may, if federal funding participation is available, provide Medical Assistance coverage of services provided in an institution for mental disease to persons ages 21 to 64.
59,929
Section 929
. 49.45 (54) (b) of the statutes is repealed.
59,930
Section 930
. 49.45 (54) (c) of the statutes is created to read:
49.45 (54) (c) Special services. From the appropriations under s. 20.435 (4) (b) and (o) and (7) (bt), the department may pay the costs of services provided under the early intervention program under s. 51.44 that are included in program participant's individualized family service plan and that were not authorized for payment under the state Medicaid plan or a department policy before July 1, 2017, including any services under the early intervention program under s. 51.44 that are delivered by a type of provider that becomes certified to provide Medical Assistance service on July 1, 2017, or after.
59,931
Section 931
. 49.46 (1) (em) of the statutes is created to read:
49.46 (1) (em) To the extent approved by the federal government, for the purposes of determining financial eligibility and any cost-sharing requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while employed and receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.
59,931n
Section 931n. 49.46 (2) (b) 6. dm. of the statutes is created to read:
49.46 (2) (b) 6. dm. Subject to the requirements under s. 49.45 (9r), durable medical equipment that is considered complex rehabilitation technology, excluding speech generating devices.
59,931p
Section 931p. 49.46 (2) (b) 6. e. of the statutes is amended to read:
49.46 (2) (b) 6. e. Subject to the limitation under s. 49.45 (30r), inpatient hospital, skilled nursing facility and intermediate care facility services for patients of any institution for mental diseases who are under 21 years of age, are under 22 years of age and who were receiving these services immediately prior to reaching age 21, or are 65 years of age or older, or are otherwise permitted under s. 49.45 (53m).
59,932
Section 932
. 49.46 (2) (b) 17. of the statutes is amended to read:
